Carpal Tunnel Release

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a condition where a nerve (which gives feeling to the thumb, index, middle and part of the ring finger) gets squeezed in the carpal tunnel of the wrist.  There are many causes for this but most commonly, the syndrome is caused by swelling in the tendons, which also pass through the same tunnel as the nerve.

This can lead to the symptoms of night waking with tingling in the fingers.  As the condition progresses, numbness becomes more common (both during the day and at night).  Eventually the numbness becomes permanent and may lead to complete loss of sensation in the affected fingers.  In addition to this if the condition is allowed to progress, loss of fine control of the hand can occur with paralysis of the muscles within the thumb.  This can be very debilitating. 

How is carpal tunnel symptom treated?

Firstly your hand will need to be assessed.  Very mild symptoms can occasionally be splinted, or if the symptoms have only been present for a few months, it may be appropriate to try a steroid injection into the carpal tunnel. 

It is important that the correct diagnosis is made before treatment.  This may be possible to be made clinically by Dr Kenton-Smith or the diagnoses may need to be confirmed with a nerve conduction study.  Dr Kenton-Smith performs nerve conduction study tests on patients whose symptoms are not clear or, in patients who have signs and symptoms of a second nerve entrapped at the elbow (cubital tunnel syndrome). 

How is carpal tunnel syndrome treated surgically?

Carpal tunnel syndrome may be treated under local anaesthetic using an open technique or it can be performed endoscopically.

What are the advantages of open carpal tunnel technique?

Dr Kenton-Smith generally performs a short scar open carpal tunnel release under local anaesthetic in his rooms.   This avoids the need for a general anaesthetic and its subsequent recovery.  This is a safer option in those people with significant medical conditions.  Open carpal tunnel release is the safest way of performing this surgery. 

What are the disadvantages of open carpal tunnel release?

Another disadvantage of open carpal tunnel release is the slightly longer recovery period, especially in heavy manual workers.  Pain along the scar, and in the thumb, can last up to three months in heavy manual workers and, in this instance, Dr Kenton-Smith will discuss the pros and cons of endoscopic carpal tunnel release.

The other disadvantage of open carpal tunnel release is that it is uncomfortable to perform surgery on both hands at once and thus the surgery would either need to be staged or Dr Kenton-Smith would discuss bilateral endoscopic carpal tunnel release. 

What is endoscopic carpal tunnel release?

Endoscopic carpal tunnel release is performed in hospital under a short general anaesthetic.  Dr Kenton-Smith reserves this method for those patients with heavy manual jobs, who require a faster return to work, and for those patients who require surgery on both hands. 

What are the disadvantages of endoscopic carpal tunnel release?

Disadvantages of endoscopic carpal tunnel release include: the increased cost of surgery and the rare chance of nerve injuries.  These risks need to be considered during your consultation with Dr Kenton-Smith. 

How much does carpal tunnel release cost?

The cost of an open, unilateral (one-sided) carpal tunnel decompression under local anaesthetic is approximately $4,600 (including surgical and theatre fees). A bilateral (both sides) carpal tunnel decompression under local anaesthetic is approximately $6,200 (including surgical and theatre fees).  The total cost under general anaesthetic is approximately $7,000 for one hand and approximately $8,000 for both hands.

How long will I take to recover?

You can return to work if you have a desk type job, or are able to perform light duties, within a few days.  You will have bandages around your hand which you may take off yourself at 5 days.  The stitches are generally removed at 10 to 14 days. 

What activity can I do whilst I recover?

Gentle hand activity and performing routine gentle tasks.  It is good for your hands during the post-operative recovery to keep mobile.  Gardening, heavy lifting or heavy manual work should be avoided for approximately a month after surgery.  Dr Kenton-Smith will discuss this in your individual case. 

In the first few days following your carpal tunnel decompression you will notice some initial improvement in your symptoms of numbness and in particular a significant improvement in night waking.  The median nerve which is affected in Carpal tunnel may take many months to recover, but as the weeks go by, gradual improvement will be noticed.  In severe cases it may take 6 months or longer for maximum recovery to occur.